Does Vision Therapy Help Myopia?

This question came up on a parent support list. Many parents are looking for trying to understand why their child is going near-sighted, and what options are available. Thoughts and comments welcome!

“My 5 year-old daughter has been diagnosed with myopia that is progressing very quickly, as well as basic esophoria, accommodative insufficiency and accommodative spasm. She began reading right when she turned 3, and now I have been told that has most likely caused these issues – too much time spent looking close up. Can anyone tell me if they have tried vision therapy for these conditions (or most specifically the myopia)?”

It might help if you look at myopia as a SYMPTOM of the vision problem, rather than as the problem itself.

The visual system has made an adaptation based on how it is being used. Your daughter has placed so much interest in working at near-point that her eyes have become specialized for this function.

The question is not whether you can treat the myopia directly, but whether you can prevent or minimize progression by helping your daughter learn how to be flexible. This is flexibility in focusing and relaxing focus, flexibility in converging and diverging the eyes, and flexibility to work with both the focusing and eye-teaming systems in tandem.

Your goal should not be to reduce the myopia (although some degree of prescription reduction is common). You are looking to support your daughter to change the cycle which is causing myopia progression.

There is a strong correlation between parents having myopia and their children developing myopia. But this may not be purely genetic! It may be from habits, which are learned (often from our parents), AND from personality traits which impact how we function. These traits may also be inherited (like tenacity!). So, identifying a HEREDITARY COMPONENT does not mean that her genes have been encoded to make her myopic no matter what. There is always a FUNCTIONAL COMPONENT as well.

Behavioral/developmental optometrists prescribe glasses for near-point (perhaps bifocals) and may prescribe activities to improve flexibility of vision function in order to stabilize and support the visual system at the problem area. The problem is visual dysfunction at near-point. The symptom is myopia (near-sightedness). If the problem is addressed, the progression of myopia will come under control. In some cases, the patient may even learn to function with a lower prescription.

In studies which do show a very positive impact from the prescription of bifocals in reducing myopia progression, the greatest effect is found in those who have ACCOMMODATIVE EXCESS (spasm) and ESOPHORIA at near-point. This implies that your daughter is among those with a strong FUNCTIONAL COMPONENT… therefore, highly remediable!

I would recommend finding a behavioral/developmental optometrist who can assess whether it is a good idea to try therapy now, or to just monitor closely with some glasses prescription changing, and initiate therapy if she is showing progression.

Best of luck!

Samantha Slotnick, O.D., F.A.A.O., F.C.O.V.D.

If you have additional questions or comments about how to manage myopia progression please share your thoughts!

16 comments on “Does Vision Therapy Help Myopia?”

Hi,
My 13 year old daughter had perfect vision through age 8. Suddenly, her vision changed and progressed very quickly (in 3 years) to -6.00 and -6.50. Two years ago, we learned she had sugar issues and that this was likely the cause of her vision issues early on. We were then told the test of the problem was that she was given glasses she probably didn’t need. That and the sugar problem took her to -6.00. Her sugar is under control now – mainly through diet and exercise. Her vision has not gotten worse either, but she is left with -6.00 and -6.50. She also cannot see up close. She sees things clearly at 4 inches from her face. Could vision therapy and vision exercises bring down her prescription?

Generally speaking, vision therapy is aimed at remediating problems in how efficiently and effectively a person uses their visual system. The purpose of vision therapy is not to reduce prescription power, although this may be a side-effect of increased flexibility in the focusing system.

The first step should be a thorough evaluation with a behavioral optometrist, to determine if there are visual skills in need of support. Your daughter may have problems with focusing and/or eye coordination. Her high prescription may have evolved due to a struggle with using her vision at near-point, and not having enough focusing ability or focusing flexibility to do the work on her own. If this is the case, there is probably room for improvement and stability.

Co-existing problems, such as “sugar issues,” as you describe, may complicate the visual status, but would not be a barrier to improvement with vision therapy.

We would be happy to evaluate your daughters’ visual system and provide more specific insight following her exam!

If you need to find a doc in your area, you can look for other visual function experts at covd.org or oepf.org.
Best wishes,
Dr. Slotnick

Hi,
My daughter is 4 yr old. She was diagnosed as myopia L -3.5 R -3.25. We need to cure it. Is it possible to cure myopia through eye exercise without wearing glasses?
If so please give me the details I will start train my kid through eye exercise.

Hello,
I recommend you have her evaluated by a behavioral or developmental optometrist. Our colleagues are trained to help support vision development. You may find one on http://www.covd.org or http://www.oepf.org.
I hope this is helpful.
Sincerely,
Dr. Samantha Slotnick

Hello,
That is a very low prescription. You may start by reading and working on your computer without your glasses, as your natural eye power is now like wearing mild reading glasses.
In addition, I strongly recommend you have your vision evaluated by a behavioral or developmental optometrist. Our colleagues are trained to help support vision development. You may find one on http://www.covd.org or http://www.oepf.org.
I hope this is helpful.
Sincerely,
Dr. Samantha Slotnick

Hi there! My daughter is 13, and her myopia is progressing rapidly. She started off in 3rd grade around a -1, and is now up to a -4.75 and -5.25. I am alarmed at this! I am myopic at -2.50 in both and her father is around -6. Her doctor wants us to try atropine drops to help but I am nervous about side effects! She wears contacts during the day and Removes them at night for which she uses her glasses. I have to keep reminding her to take off her glasses for close work and I’m sure her iPhone is not helping, even though I limit it. I am reading literature regarding using +lenses for close work to shorten the cornea. Is this what vision therapy entails? I want to try and stop this rapid progression. Please help!

Hello, and sorry for the delayed reply. I did not catch your message!
It is possible to address the underlying visual dysfunctions which promote the development of myopia. Success varies by clinician. If you are local, I would invite you to come to a workshop to learn more about how vision develops, including adaptations like myopia. Please contact me privately to discuss specifics, or for a referral near you. Use our “contact” link.
Thank you and good luck!

Hello, and thank you for asking.
It is possible to work on the risk factors which are underlying your myopic progression. That is, a halt in progression is a reasonable goal for vision therapy. Reversal in myopia is a possibility, but is not something which can be assured. Personally, by addressing my own binocular dysfunctions which triggered the development of myopia as an adaptation, I experienced a six-step reversal of myopia (from -2.75 to -1.25). This is not typical, but it is possible.
I suggest seeking the input of a behavioral optometrist who does vision therapy. If they can identify underlying functional vision problems, these can be addressed.

Hi . I have always had helqthy and strong eyes and everytime I went to an eye doctor they always told me you will never have problems with your eyes because they saw the shape of them I don’t have it inherit . After 16 years old the doctor told me I needed yo wear glasses for far and my prescription was -0.5 the left eye and -1.00 the rughtt eye. I feel terribly bad and I don’t know what happened with my eyes they were perfectlu fine . I am so desperate and I want to know if I go undergo through a therapy to correct my vision due to my number of eyes which is not too high. Thank you in advence .

Hi Lorena,
Developing myopia does not mean that you do not have healthy eyes. However, it implies that you have been exerting excess stress when viewing at near-point. Your eyes have made an adaptation so that reading is less of a challenge for you.
It is possible that you can seek out the input of a behavioral/developmental optometrist for some guidance and support. This may include reading lenses to alleviate visual stress at near, and help you preserve your distance vision. This may include activities, some of which you can do at home, with guidance, to build your focusing skills.
I am glad you are acting on the problem while you may still be able to reverse some of the change. If you would like a referral, please contact me with our web-form, and let me know where you are (with zip code, if in the US or Canada).
Good luck!
Dr. Slotnick

Dear Hifzur,
That’s a VERY high prescription! A prescription this high is often associated with a genetic predisposition. However, there may still be a functional component, where inefficient use of vision encourages the development of myopia.
The goal of Optometric Vision Therapy in all cases of myopic progression is to remediate the visual skills which may be contributing to the mal-adaptation of myopia. This requires a comprehensive evaluation with a behavioral or developmental optometrist, to analyze your child’s visual input skills.
If your child shows accommodative infacility (problems controlling the focusing system) AND/OR inefficient eye-teaming skills, especially if there is a tendency to over-converge at near, then the remediation addresses these core issues which contribute to myopia progression. Remediation should also include use of peripheral vision, and visual-motor integration skills at different distances (near, mid-ground, and far).
For more on how myopia develops, please see related blog post, here: http://drslotnickblog.com/2016/08/myopia-progression/
For more on the changes to quality of life with optometric vision therapy for patients with myopia, please see article, here: http://drslotnickblog.com/2017/02/vision-therapy-enhances-quality-life-patients-myopia/

Please arrange to find a behavioral optometrist near you in order to determine if there are contributing factors which can be addressed in an optometric (or ‘neuro’) vision therapy program. If you’d like to write me a private message with your location (zip code helpful), I can try to suggest a colleague near you.
Best wishes!
Dr. Slotnick